Researchers Eran Bendavid, MD,
and Jayanta Bhattacharya, MD, PhD,
from Stanford University recently released findings from their study
on the effectiveness of PEPFAR’s programs in the article "The President’s
Emergency Plan for AIDS Relief in Africa: An Evaluation of Outcomes."
The report, released in the Annals of Internal Medicine, found
that the U.S. effort to curb the global HIV/AIDS epidemic has been a
mixed bag. The study found that significant progress has been
made in the areas of care and treatment, a laudable accomplishment of
the first phase of implementation. But the report also confirmed
what too many of us had seen coming – we have not made any significant
progress in curbing new infections because our prevention efforts have
failed. And while the oft quoted truism that we cannot treat our
way out of this epidemic is spot on, we must also now couple this with
an equally true mantra: politically- and ideologically-based prevention
will not work.

SIECUS has long been critical
of the prevention paradigm in the Bush Administration’s global HIV/AIDS
efforts and at the end of this month, will release Making Prevention
Work: Lessons from Zambia on Reshaping
the U.S. Response to the Global HIV/AIDS Epidemic.
This report is based on interviews and on-the-ground research by SIECUS
staff that traveled to Zambia one of the countries hardest hit by
the HIV/AIDS epidemic in Sub-Saharan Africa and, therefore, the world.

For those of us who closely
follow the global HIV/AIDS epidemic, the numbers of new infections coming
out of Zambia confirms in real life, the findings of the Stanford report: without the right policies and adequate resources, the HIV/AIDS epidemic
continues to wreak havoc. No single government or organization,
international or otherwise, is solely responsible for the current situation
in Zambia. Rather, it is the result of a failure to integrate
sound, responsible policies at the international level while prioritizing
effective execution of strategies on the ground. In other words,
where none are to blame, all are to blame.

Making Prevention Work
will not only shine a spotlight on, and give a better understanding
of, the realities faced by those struggling against the HIV/AIDS epidemic,
but also provide sound, evidence-based policy recommendations designed
to improve the response. While those of us in the U.S. can never
presume to put ourselves in the shoes of the dedicated workers and volunteers
who are doing their best in Zambia every day, we can take care of business
on our side – strengthening the largest source of money on earth to
fight HIV/AIDS, the President’s Emergency Plan for AIDS Relief (PEPFAR).
While PEPFAR does a great deal of good now, particularly in the areas
of treatment and care, the prevention portfolio must be reshaped
and fine-tuned into a tool to turn the tide in this global conflict
against HIV/AIDS. This is the focus of our recommendations.

For those of us who focus on
domestic issues, the numbers and crisis facing Zambia and Sub-Saharan
Africa can seem daunting and almost incomprehensible. For example,
the HIV prevalence rate in Zambia is 15.2%. But what does that
look like? What does that number represent? Think about
it this way: imagine if the entire population of the state of Oregon
were HIV positive. Think of the national outcry and response of
the federal government to what would obviously be an enormous national
crisis. Now, see if you can handle this. In fact, 15.2%
of the U.S. population would not only constitute the population of Oregon,
but also add to this the equivalent of every man, woman, and child in
Oklahoma, Connecticut, Iowa, Mississippi, Arkansas, Kansas, Utah, Nevada,
New Mexico, West Virginia, Nebraska, Idaho, Maine, New Hampshire, Hawaii,
Rhode Island, Montana, Delaware, South Dakota, Alaska, North Dakota,
Vermont, Washington, D.C., and Wyoming.

That is the scale of the crisis
Zambia is facing.

Not all is lost, however.
During the last 20 or so years, our knowledge about HIV/AIDS treatment
and prevention has come light years, and there is no reason why we cannot
lower rates of transmission and ensure access to treatment if we finally
take the steps that are necessary to show that we are serious in our
fight.

With new leadership at the
helm, now is the time to take a close and introspective look at our
global HIV/AIDS efforts and make an informed and deliberate choice about
how to proceed. Zambia is a case study on our nation’s success
and failures in helping this amazing country deal with the moral crisis
of our time. We here at SIECUS hope the report will be received
in that spirit and it will make seven concrete recommendations for moving
forward. Until then, our previous postings on lessons from Zambia can
be found here: